1033552047 NPI number — NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC

Table of content: (NPI 1033552047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033552047 NPI number — NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033552047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 NORTHPOINTE LANE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
RUSTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71270-3852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-255-1155
Provider Business Mailing Address Fax Number:
318-255-3181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 NORTHPOINTE AVE.
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-255-1155
Provider Business Practice Location Address Fax Number:
318-255-3181
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLAS
Authorized Official First Name:
LUCY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-255-1155

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  AP06950 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AP06950 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: PA021491 . This is a "PRESCRIPTIVE AUTHORITY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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